Asunto(s)
Prestación Integrada de Atención de Salud , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Adulto , Anciano , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/economía , Enfermedad Hepática en Estado Terminal/epidemiología , Femenino , Costos de la Atención en Salud , Humanos , Cooperación Internacional , Kuwait/epidemiología , Trasplante de Hígado/economía , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
ABSTRACT Introduction. To identify the impact of portal vein thrombosis (PVT) and associated medical and surgical factors on outcomes post liver transplant (LT). Material and methods. Two analyses were performed. Analysis One: cohort study of 505 consecutive patients who underwent LT (Alberta) between 01/2002-12/2012. PVT was identified in 61 (14%) patients. Analysis Two: cohort study of 144 consecutive PVT patients from two sites (Alberta and London) during the same period. Cox multivariable survival analysis was used to identify independent associations with post-LT mortality. Results. In Analysis One (Alberta), PVT was not associated with post-LT mortality (log rank p = 0.99). On adjusted analysis, complete/occlusive PVT was associated with increased mortality (Hazard Ratio (HR) 8.4, p < 0.001). In Analysis Two (Alberta and London), complete/occlusive PVT was associated with increased mortality only on unadjusted analysis (HR 3.7, p = 0.02). On adjusted analysis, Hepatitis C (HR 2.1, p = 0.03) and post-LT portal vein re-occlusion (HR 3.2, p = 0.01) were independently associated with increased mortality. Conclusion: Well-selected LT patients who had PVT prior to LT had similar post-LT outcomes to non-PVT LT recipients. Subgroups of PVT patients who did worse post-LT (complete/occlusive thrombosis pre-LT, Hepatitis C or post-LT portal vein re-occlusion) warrant closer evaluation in listing and management post-LT.
Asunto(s)
Vena Porta , Trasplante de Hígado , Trombosis de la Vena/complicaciones , Enfermedad Hepática en Estado Terminal/cirugía , Cirrosis Hepática/cirugía , Vena Porta/diagnóstico por imagen , Factores de Tiempo , Distribución de Chi-Cuadrado , Modelos de Riesgos Proporcionales , Análisis Multivariante , Estudios Retrospectivos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/mortalidad , Resultado del Tratamiento , Hepatitis C/complicaciones , Trombosis de la Vena/cirugía , Trombosis de la Vena/mortalidad , Trombosis de la Vena/diagnóstico por imagen , Estimación de Kaplan-Meier , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/virología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/mortalidad , Cirrosis Hepática/virologíaRESUMEN
INTRODUCTION: To identify the impact of portal vein thrombosis (PVT) and associated medical and surgical factors on outcomes post liver transplant (LT). MATERIAL AND METHODS: Two analyses were performed. Analysis One: cohort study of 505 consecutive patients who underwent LT (Alberta) between 01/2002-12/2012. PVT was identified in 61 (14%) patients. Analysis Two: cohort study of 144 consecutive PVT patients from two sites (Alberta and London) during the same period. Cox multivariable survival analysis was used to identify independent associations with post-LT mortality. RESULTS: In Analysis One (Alberta), PVT was not associated with post-LT mortality (log rank p = 0.99). On adjusted analysis, complete/occlusive PVT was associated with increased mortality (Hazard Ratio (HR) 8.4, p < 0.001). In Analysis Two (Alberta and London), complete/occlusive PVT was associated with increased mortality only on unadjusted analysis (HR 3.7, p = 0.02). On adjusted analysis, Hepatitis C (HR 2.1, p = 0.03) and post-LT portal vein re-occlusion (HR 3.2, p = 0.01) were independently associated with increased mortality. CONCLUSION: Well-selected LT patients who had PVT prior to LT had similar post-LT outcomes to non-PVT LT recipients. Subgroups of PVT patients who did worse post-LT (complete/occlusive thrombosis pre-LT, Hepatitis C or post-LT portal vein re-occlusion) warrant closer evaluation in listing and management post-LT.
